Following breast cancer survival. For estrogen receptor-positive tumors,

Following lung cancer, breast cancer is the second
highest cause of cancer death among African American women, and from 2008-2012
African American women were 42% more likely to die compared to white women (“Report,” n.d.). This gap is
expected to continue widening. Interventions
are needed to reduce racial disparities in breast cancer survival. For estrogen
receptor-positive tumors, African American women were 2.65 times as likely to die
compared to white women in the first two
years (Warner et al., 2015). Blacks were
76% and 56% more likely to die as a result of luminal A-like and luminal B-like
tumors, respectively (Warner et al., 2015). Even less-than-weekly religious
service attendance was positively associated
with annual mammograms (1.34), breast self-exams  (1.14), PAP smears (1.22), non-smoking (1.41) (Salmoirago-Blotcher et al., 2011). This study will address the research
question: Is religious affiliation
(Muslim, Christian, Jewish, versus none) a protective factor for breast cancer
death among African American women?

The long-term goal is to determine if
religious affiliation reduces breast cancer mortality in African
American women. The specific objective of this proposal is to
determine if one particular religious affiliation (Muslim, Christian, Jewish,
versus none) and a specific worship frequency (never, less than monthly,
weekly-monthly, more than weekly)  a
reduced risk of breast cancer death. The conceptual hypothesis is that the affiliation with a religion
increases the probability of survival in African American women with breast
cancer. The
operational hypothesis is that in a
Washington, DC, Prince Georges County and Montgomery County, MD hospital-based
sample of recently diagnosed  African
American women with breast cancer ages 18-60, those who attend religious
service more than weekly will report decreased mortality over a 2 year
follow-up period when compared to a comparable group of women with no religious
affiliation.This hypothesis
was formulated based on preliminary data,
which states that African American women who attend religious services engage
in protective behaviors like mammograms and breast exams. There are racial
disparities in the stage of diagnosis between black women and white women, only 52% of black women are diagnosed at a local stage versus
63% of white women (“Report,” n.d.). Late stage diagnosis has been attributed to a lower
frequency of mammograms (“Report,” n.d.).

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We are proposing a 2-year
prospective cohort study on newly
diagnosed African American women with breast cancer (within the previous
six months of study initiation) in Washington, DC, Prince Georges County and
Montgomery County, MD. In
2011, the 5-year survival rate among African American women with breast cancer was 80%, making incidence on death
not rare (“Report,” n.d.). Cohort studies are not suitable for rare diseases. Thus
this had to be ruled out when a picking study design. A cohort design was chosen to eliminate
temporal ambiguity. Also, if we did a retrospective design or case-control, we would have to rely on
potentially incomplete data or proxy answers
because the outcome is death. Since religion can be personal, a proxy is not
ideal. Also, having a proxy complete an
interview for only the fatalities
would create information bias due to differences in measurement. Because
previous studies noted that intervention is particularly vital in the first two
years, the induction period is not an unrealistic study period for a
prospective cohort and there should be a minimal
loss to follow-up due to migration (Warner et al., 2015).

The outcome
of interest is death due to breast cancer.
The outcome will be measured by a
categorical variable “Breast Cancer Mortality,” yes=1 and no=0. This
information will be gathered from death
certificates and confirmation calls to the participant’s
physicians. The exposure is religious
affiliation. Participants will be
interviewed at baseline, after screening. Religious affiliation will be
measured by two categorical variables “Affiliation” and “Worship
Frequency.” Religious affiliation will
provide the following choices Muslim, Christian, Jewish, and None, and
participants will be asked which belief
fits them most. Then participants will be asked about “Worship Frequency,” and asked how often they attend religious
services (never, less than monthly, weekly-monthly, more than weekly). Modifiers
are variables that enhance the effect of the exposure on the outcome.There are a few potential modifiers,
including the stage of diagnosis, treatment method, and smoking. AJCC
clinical stage of breast cancer will be noted
at baseline interview, a categorical variable of
stages 0, 1, 2, 3, and 4. Treatment method will be noted during follow-up interviews,
a categorical variable of surgery, radiation, chemotherapy, and
other. Prevalence of smoking measured at baseline with a categorical variable of never smoked, quit smoking,
social smoking, frequent smoking. Previously we noted the increased protective
effect of religious affiliation on smoking
and mammograms. The correlation of mammograms and early stage diagnosis and survivability
were also noted.
Thus, these protective factors will probably modify the affect religious
affiliation has on breast cancer survival.